Osteoporosis and Bone Health Flashcards
What is osteoporosis?
Loss of bone mass with bone mineral density (BMD) < 2.5 standard deviation below the young adult mean density
BMD decreases with age, making osteoporosis a significant concern for older adults.
What does osteoporosis increase the risk of?
Fragility (non-traumatic) fractures
This risk is particularly high in post-menopausal women.
List major risk factors for osteoporosis.
* Corticosteroid use
* Rheumatoid Arthritis
* Current Smoking
* Alcohol excess
* Low BMI
* Family history - hip fractures
These factors significantly contribute to the likelihood of developing osteoporosis.
What are some other risk factors for osteoporosis?
- Sedentary lifestyle
- Premature menopause
- Caucasian/Asian ethnicity
- Endocrine disorders (e.g., hyperthyroidism, hypogonadism)
- Multiple myeloma, lymphoma
- GI disorders (IBD)
- CKD
- Osteogenesis imperfecta
- Medications (SSRIs, antiepileptics, PPIs, glitazones, long-term heparin use, aromatase inhibitors)
These additional factors can also increase the risk of developing osteoporosis.
What screening tools are used for osteoporosis fragility fracture risk?
- FRAX
- Q-Fracture
These tools assess the 20-year risk of developing fragility fractures.
What does a FRAX score indicate?
Risk of osteoporisis is given by colour (green, orange, red)
Orange + red need a DEXA scan.
FRAX is a widely used tool in clinical practice.
What is the threshold for a DEXA scan based on Q-Fracture?
10-year fracture risk is ≥ 10% then a DEXA scan should be arranged
Q-Fracture helps determine the need for further investigation.
What investigations should be carried out after diagnosing osteoporosis?
- Exclude diseases that mimic osteoporosis
- Identify the cause
- Assess risk of subsequent fractures
- Select most appropriate treatment
These steps are crucial for effective management.
What blood tests are important in osteoporosis investigations?
- ESR/CRP
- Serum Ca
- Albumin
- Creatinine
- Phosphate
- ALP
- ALT/AST
- TFTs
- PTH
These tests help rule out other conditions and assess bone health.
What does a DEXA scan assess?
Bone mineral density at the hip and lumbar spine
A T score < -2.5 indicates that treatment is recommended.
What is the management approach for patients aged 75 and older?
Start first-line therapy without need for DEXA scan
This age group is at higher risk and requires prompt treatment.
What should be done for patients on corticosteroids?
Start bone protection straight away if taking prednisolone 7.5mg a day for 3 or more months
Corticosteroids significantly increase fracture risk.
What is the first-line treatment for osteoporosis?
Oral bisphosphonate e.g. Alendronate, Risedronate (1 x weekly)
These medications are effective in reducing fracture risk.
What is the second-line treatment for osteoporosis?
Denosumab
This is used when first-line treatment is not effective or tolerated.
What is the first-line treatment following a hip fracture?
IV zoledronate (yearly)
Patients with a hip fracture require urgent treatment to prevent further complications.
True or False: Patients should be reviewed after 5 years of osteoporosis treatment.
True
Regular review is essential to assess treatment efficacy and adjust as necessary.
What scoring system is used by the DEXA (Dual-energy X-ray absorptiometry) scan to indicate osteoporosis?
- DEXA scan looks at hip and lumbar spine
- T score < -2.5 indicates treatment is recommended.
